Planning a Hospital Strategy for Broadband, Telehealth Expansion
Industry analyst Craig Settles says health systems planning on expanding their telehealth and telemedicine programs should be proactive in securing broadband, rather than waiting for the connectivity to come to them.

“Unless broadband in the US improves, the promise of telehealth will stall,” says Craig Settles, a business strategist and industry analyst.

With recent initiatives like the proposed $100 million Connected Care Pilot Program and the expansion of the Universal Service Fund’s Rural Healthcare Program, the Federal Communications Commission has signaled its interest in improving rural connectivity across the country. Similarly, Microsoft has unveiled a five-year plan to encourage broadband expansion, and a new coalition called Connect Americans Now is keeping the pressure on lawmakers to make rural connectivity a reality.

“All Americans – regardless of where they live – deserve access to high-speed Internet,” CAN Execute Director Richard T. Cullen said in a press release issued this past January. “Without a broadband connection, millions of students struggle to keep up with their assignments, Americans in rural areas are unable to fully utilize telemedicine, farmers are denied the promise of precision agriculture and businesses are unable to tap into the world of online commerce. Congress and the FCC must stand with rural America by allowing Internet service providers to deliver broadband via white spaces spectrum.”

In the meanwhile, what should hospitals and health systems be doing now to match available their broadband resources with connected care programs, and how should they be planning for future needs and programs?

mHealthIntelligence recently sat down with Settles, the author of a 2107 report titled Telehealth & Broadband: In Sickness and in Health, to map out the healthcare provider’s strategy.

Q. How can a hospital or health system effectively use broadband to expand its telehealth programs?

A. Actually, it's not a question of expanding. If you don't have a connection with the Internet, or an intranet, you don't have telemedicine. Period. The question is, really, how good is the quality of the broadband that delivers your telehealth services or products. The problem in America is that you have swaths of urban and rural communities that have poor or no Internet access. Unless their situations change, telehealth isn't going to those areas.

Q. What should a hospital or health system look for in a telecommunications platform – what is needed to create a good telehealth or telemedicine platform?

A. There are four things that define the quality of community broadband, features that also deliver effective telehealth and telemedicine. Are these respective technologies 1) reliable, 2) secure, 3) fast enough to get the job done well, and 4) affordable? By reliable I also mean the provider’s business has to be as reliable as the equipment, maybe more so. 

Q. How can health systems develop partnerships (municipal, school, healthcare) to promote or expand broadband services?

A. Telehealth vendors can set up a revenue-sharing arrangements with community broadband owners. Or these venders can partner with school districts. The muni or co-op should be invested in the provider’s success in the community, just as the provider should feel invested in the community network's success.

Q. Will the FCC's plan to increase rural connectivity help health systems in their telehealth/telemedicine efforts? What are the positive and negative aspects of this strategy?

A. The FCC’s stated desire to increased rule productivity may just be a lot of lip service. The way the rules of the FCC’s funding programs are structured, these programs become cash giveaways to big telcos and cable companies for providing weak speeds, crappy quality and crappier customer service. That’s not good for telehealth.

The three FCC majority commissioners' definition of what defines broadband speed is pathetic. FCC broadband maps have zones marked as being covered when there may be as few as just one home with broadband. Rules for FCC broadband funding for healthcare are skewed away from local private or public entities. 

The FCC has initiate a Notice of Inquiry (NOI) seeking comment by September 10 on (the proposed Connected Care Pilot Program). I expect one of two things will happen as a result of this fund. One, most of the $100 million will find its way to incumbents and there'll be little accountability regarding how that money is used. Or two, the FCC will run a series of pilot projects testing a variety of solutions, and as a result some new approaches to deploying broadband and telehealth will surface. This approach was used during the last administration. Subsequently I'm not betting on the latter outcome.

Q. If the FCC's plan doesn’t work, what should the government do to improve rural connectivity and help health systems get the technology they need to expand telehealth?

A. Local governments should take action. There are over 750 public-owned networks run by local governments or public utilities. Dozens of municipalities are moving forward to join them. Over 80 electric cooperatives are running or building networks as well.  

Many municipalities and co-ops are providing gigabit speeds that are hundreds of times faster than incumbents, assuming they are even providing coverage at all, and for lower costs. Wireless ISPs are local and deliver fast broadband where incumbents fear to tread. And like public and co-op broadband, local private-sector providers often are the epitome of quality customer service, especially if the municipality provides core fiber.

Q. Are there other avenues of funding/support that hospital and health systems should consider when looking to expand broadband for telehealth and telemedicine?

A. Say a community wants to do some economic fundraising to generate $10 million for broadband. Switch the goal. Tell people you want to raise $14 million to create a telehealth umbrella that covers the community. And oh, by the way, we need a broadband component to deliver the telehealth. It’s much easier to raise big money for specific initiatives such as improved state-of-the-art healthcare than fiber and wireless routers for what half the population feels is for entertainment or porn. 

Q. Are there new technologies or concepts on the horizon that could help healthcare providers improve their broadband connectivity and expand their telehealth/telemedicine services?

Source: Planning a Hospital Strategy for Broadband, Telehealth Expansion

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